Severe Head Injury, Causes, Diagnosis, Treatment, Prevention, Complications

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Severe Head Injury, Causes, Diagnosis, Treatment, Prevention, Complications

A severe head injury is a condition when a person experiences an impact or hard pressure on the head which causes severe injury to the brain. If not treated quickly and appropriately, this condition can be fatal.

Severe head injuries can be caused by many things. Traffic accidents and experiencing physical violence are some of the events that often cause a person to experience this condition.

Based on the cause, head injuries can be divided into two types, namely:

Closed head injury
This condition can occur due to a hard impact or jolt to the head which results in injury to brain tissue, even though the skull bones are still intact.
Open head injury or penetrating wound
This condition can occur due to a blow that causes the skull to break or an object that penetrates (penetrates) the skull and brain, for example being shot in the head by a bullet.

Causes of Severe Head Injury

Severe head injuries can result from a blow, pressure, penetration, or a hard jolt to the head. Some of the common events that can lead to a severe head injury are:

Fall down
Injury while exercising
Traffic accident
Physical abuse
Explosion of explosives or other materials

Serious head injuries can happen to anyone, but these conditions are generally more at risk for:

Man
Children, especially those less than 4 years old
Young adults, especially those aged 15–24
Seniors, aged 60 years and over

Symptoms of Severe Head Injury

Severe head injury has a variety of symptoms that affect the sufferer physically and psychologically. Symptoms can appear immediately or several hours, even days after the head injury.

The following are some of the physical symptoms that can be experienced by sufferers of severe head injuries:

Dizzy
Severe headache
Stiff neck
Difficult to speak
Difficult to breathe
Difficulty moving some parts of the body
Bruising and swelling around the eyes or around the ears
Damage to the bones of the skull or face
Disturbances in the body senses, such as hearing loss or experiencing double vision
Constant vomiting and gushing
Blood or clear fluid coming out of the ears or nose
Disorientation or not being able to recognize time, place, and people
Inability to move arms or legs
Changes in the size of the pupil of the eye
Seizure
Loss of consciousness
Amnesia

While the psychological symptoms that can be experienced by sufferers of severe head injuries include:

Being irritable
Feeling anxious or depressed
Having problems with memory and concentration

In children, symptoms may include:

Changes in diet or breastfeeding
Changes in sleep patterns
Fussy
gloomy
Loss of interest in favorite activities or toys
It's hard to stop crying
Losing focus
Looks sleepy
Seizure

When to go to the doctor

Take them to the doctor immediately if someone experiences a blow or injury to the head until symptoms appear that indicate a severe head injury, especially if the person experiences more serious symptoms, such as stopping breathing.

A person who has the following conditions should be taken to a doctor immediately if they experience a blow or injury to the head:

Have you ever had brain surgery?
Taking alcohol or drugs before, especially drugs that can cause bleeding disorders, such as warfarin
Have you ever had a bleeding or blood clotting disorder?
Injuries occur due to a fairly hard impact, for example from being hit by a car or falling from a height of one meter
Injuries occur as a result of something intentional, such as being hit by someone else

Diagnosis of Severe Head Injury

As a first step, the doctor will perform first aid to stabilize the patient's breathing, heart rate, and blood pressure. After the patient's condition is stable, the doctor will ask several questions regarding the symptoms and events that can be the cause of the head injury.

However, if the patient is unconscious, the doctor can request information from the person who brought the patient to the hospital. After that, the doctor will perform a thorough physical examination, including a neurological examination.

The doctor will use the Glasgow Coma Scale (GCS) to assess the patient's consciousness and identify the severity of the head injury. The GCS value is determined based on three factors, namely:

Verbal response
Physical movement
Easy eye opening

The value of each of the factors above will be added up to produce a total score. Based on this total score, head injuries are classified into 3 levels of severity, namely:

Minor head injury: total score is on a scale of 13–15
Moderate head injury: total score is on a 9–12 scale
Severe head injury: total score is on a scale of 8–3

A score of 15 (highest score) indicates that the patient is fully conscious, can open his eyes spontaneously, speak and receive instructions. Meanwhile, a scale value of 3 (lowest score) indicates the patient is in a coma.

If needed, the doctor will also perform additional examinations, such as a CT scan or MRI, to get an image of the broken bone and detect possible bleeding in the brain, blood clots (hematoma), bruised brain tissue (contusions), or swelling of brain tissue.
Treatment of Severe Head Injury

Generally, people with severe head injuries undergo intensive treatment in the hospital to reduce the risk of complications. Some of the treatment methods that can be used to treat severe head injuries are:

First aid

In providing first aid to patients with severe head injuries, doctors will usually take the following actions:

Check breathing, heart rate and blood pressure
Perform cardiopulmonary resuscitation (CPR), when the patient experiences respiratory or cardiac arrest
Stabilize the neck and spine with a neck brace or spinal brace
Stop bleeding
Give intravenous fluids to prevent hypovolemic shock due to bleeding
Bandages cracked or broken bones
Prescribing pain relievers

Observation

After the patient's condition is stable, the doctor will recommend observation in the intensive room, where medical personnel will conduct periodic checks on:

Level of consciousness
The size of the pupil of the eye and its reaction to light
How well the patient moves the hands and feet
Breathing, heart rate, blood pressure, body temperature, and blood oxygen levels

Operation

The doctor will perform surgery if the patient with severe head injury has one or more of the following conditions:

Brain hemorrhage
Blood clots in the brain
Brain contusion (cerebral contusion)
Fracture of skull
Presence of foreign objects, such as broken glass or bullets

One of the surgical procedures that doctors can perform is a craniotomy, which is an operation by opening the skull. The stages of the craniotomy procedure include:

The doctor will make a hole in the skull for access to the brain.
The doctor will remove any blood clots that may have formed and repair the damaged blood vessels in the brain.
After the bleeding in the brain has stopped, the pieces of skull bone will be placed back in their original position and reattached with special nuts.

Treatment of skull fractures

Severe head injuries are sometimes accompanied by skull fractures. If the fracture is severe, this condition is at risk of causing infection and increasing pressure on the brain. The doctor may perform the following actions to treat it:

Give antibiotics if there is an open fracture to prevent infection
Perform surgery to repair broken bones or remove bone fragments in the brain

However, in cases where the skull has only minor fractures, the above measures may not be necessary as the condition generally resolves on its own within a few months.

The chances of recovery for patients with severe head injuries depend on the treatment provided. The sooner the condition is treated, the higher the chance of recovery. In addition to treatment, doctors can also give neuroprotector drugs, such as citicoline, to support brain recovery.

Complications of Severe Head Injury

A severe head injury can cause damage to the brain and lead to serious complications that can be fatal. Complications can occur temporarily or permanently. Some complications of severe head injury that may occur are:

Infection

The risk of infection is higher if a severe head injury is accompanied by a skull fracture. This is because skull fractures can tear the thin protective layer of the brain. If this happens, bacteria can enter the brain and cause a brain infection.

Impaired consciousness

Some people with severe head injuries can experience disturbances of consciousness, such as coma and vegetative state, which is a condition when the patient is conscious but unresponsive.

Symptoms after concussion

A severe head injury can cause a concussion. Some patients may experience long-term symptoms from a concussion, such as:

Constant headaches
Sleep disturbance
Memory impairment
Poor concentration
Tinnitus

The above symptoms generally last for 3 months. Patients need to consult a doctor immediately if they feel these symptoms.

Brain injury

A severe head injury can cause injury and brain damage. Brain injury or damage can cause a variety of disorders, including:

Epilepsy
Impaired balance and loss of body coordination
Impaired function of the senses of taste and smell
Difficulty thinking, processing information, and solving problems
Behavioral and emotional changes

Prevention of Severe Head Injury

Events that can lead to severe head injuries tend to occur suddenly and are difficult to completely prevent. However, there are several things that can be done to reduce the risk of injury to the head. These include:

Use personal safety equipment when driving a motor vehicle and when exercising.
Avoid driving under the influence of alcohol or drugs that can affect alertness.
Make sure the house is free of objects that can make you fall, such as items scattered on the floor or slippery carpet.
Make sure the house is safe for children, for example by making sure windows or balconies are out of reach of children.

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